Therapeutic effects of electrospun chitosan nanofibers on animal skin wounds: A systematic review and meta-analysis

Abstract

Electrospun chitosan nanofibers (QSNFs) enhance the healing process by mimicking skin structure and function. The aim of this study was to analyze the therapeutic effects of QSNFs application on animal skin wounds to identify a potential direction for translational research in dermatology. The PRISMA methodology and the PICO scheme were used. A random effects model and mean difference analysis were applied for the meta-analysis. A meta-regression model was constructed, risk of bias was determined, and methodological quality assessment was performed. Of the 2370 articles collected, 54 studies were selected based on the inclusion and exclusion criteria. The wound healing area was used for building models on the 3rd, 7th, and 14th days of follow-up; the results were - 10.4% (95% CI, -18.2% to -2.6%, p = 0.001), -21.0% (95% CI, -27.3% to -14.7%, p = 0.001), and - 14.0% (95% CI, -19.1 to -8.8%, p = 0.001), respectively. Antioxidants and synthetic polymers combined with QSNFs further reduced skin wound areas (p < 0.05). The results show a more efficient reduction in wound area percentages in experimental groups than in control groups, so QSNFs could potentially be applied in translational human medicine research.

Keywords: Animal; Capsaicin (PubChem CID: 1548943); Chitosan; Chitosan (PubChem CID: 71853); Collagen (PubChem CID: 9928521); Dihydroquercetin (PubChem CID: 471); Ethylene Glycol (PubChem CID: 174); Full-thickness skin wound; Healing; Nanofibers; Poly (lactic acid-co-glycolic acid) (PubChem CID: 71391); Polycaprolactone (PubChem CID: 57529352); Polyvinyl alcohol (PubChem CID: 11199); Polyvinylpyrrolidone (PubChem CID: 154932); Zinc oxide OZn (PubChem CID: 14806).

Graphical abstract

Fig. 1

Flowchart of the literature search and selection process.

Fig. 2

Forest plot diagram of included studies. The effects of QSNFs application on the wound healing percentage on the (A) 3^rd, (B) 7^th, and (C) 14^th days of follow-up (Al-Musawi et al., 2020; Balan et al., 2022; Bayat et al., 2019; Bazmandeh et al., 2020; Charernsriwilaiwat et al., 2014; Chogan et al., 2020; Ehterami et al., 2018; Ghasemian Lemraski et al., 2021; Gholipour-Kanani et al., 2014; Gholipour-Kanani et al., 2018; Ho et al., 2021; Kamali and Shamloo, 2020; Li et al., 2013; Nada et al., 2020; Naeimi et al., 2020; Pathalamuthu et al., 2019; Sapru et al., 2018; Sarhan et al., 2016; Sharifi et al., 2022; Sun et al., 2019; Sundaramurthi et al., 2012; Tort et al., 2020; Veleirinho et al., 2012; Woo et al., 2015; Xia et al., 2020; Xie et al., 2013; Yao et al., 2019; Zhang et al., 2019).

Fig. 2

Forest plot diagram of included studies. The effects of QSNFs application on the wound healing percentage on the (A) 3^rd, (B) 7^th, and (C) 14^th days of follow-up (Al-Musawi et al., 2020; Balan et al., 2022; Bayat et al., 2019; Bazmandeh et al., 2020; Charernsriwilaiwat et al., 2014; Chogan et al., 2020; Ehterami et al., 2018; Ghasemian Lemraski et al., 2021; Gholipour-Kanani et al., 2014; Gholipour-Kanani et al., 2018; Ho et al., 2021; Kamali and Shamloo, 2020; Li et al., 2013; Nada et al., 2020; Naeimi et al., 2020; Pathalamuthu et al., 2019; Sapru et al., 2018; Sarhan et al., 2016; Sharifi et al., 2022; Sun et al., 2019; Sundaramurthi et al., 2012; Tort et al., 2020; Veleirinho et al., 2012; Woo et al., 2015; Xia et al., 2020; Xie et al., 2013; Yao et al., 2019; Zhang et al., 2019).

Fig. 3

Meta-regression of the wound healing effect of the application of QSNFs with antioxidants (A) and QSNFs with synthetic polymers (B).

Fig. 4

Assessment of the risk of bias and quality of the publications included.